Manipulative physiotherapy is the term used to
describe the field of physiotherapy practice which relates to
disorders of the musculoskeletal system. Physiotherapists who
practise in this area, are skilled in the assessment, diagnosis and
physiotherapy management of musculoskeletal conditions.
physiotherapy profession recognises the importance of evidence based
practice and actively encourages practitioners to consider the
scientific evidence when developing management programs. So what is
the evidence for manipulative physiotherapy practice?
Manipulative physiotherapy works
physiotherapists are highly trained in assessing musculoskeletal
disorders. The clinical reasoning processes employed by manipulative
physiotherapists enables them to reach a diagnosis consistent with
the findings of the clinical examination.
Research has shown
that manipulative physiotherapists are highly skilled in their
examination such that they are able to form a diagnosis similar to
or better than those determined by sophisticated imaging processes.
For example, studies have shown that manipulative physiotherapists
are skilled in the diagnosis of symptomatic facet joints (Philips
and Twomey 1996), symptomatic intervertebral discs (Donelson et al
1997) and lumbar instability (Avery 1997).
physiotherapists have advanced skills in the assessment, diagnosis
and management of musculoskeletal conditions. These skills assist
the medical practitioner with accurate, cost effective diagnosis and
appropriate evidence based management. Manipulative physiotherapists
in Australia have world leading expertise in the effective
management of pain and other disorders related to the
Evidence on the effectiveness of
physical treatments as practiced by manipulative physiotherapists is
constantly being reviewed. The Manipulative Physiotherapists
Association of Australia (MPAA) has recently reviewed the literature
on low back pain, based on level I evidence (systematic reviews) and
level II evidence (randomised controlled trials).
manipulative therapy (SMT - including both passive mobilisation and
manipulation), McKenzie therapy and promoting early activity is
effective in the short-term management of low back pain (ACHPR 1994,
van Tulder et al 1997). General exercise programs designed and
supervised by physiotherapists result in reduced disability, reduced
absenteeism and faster return to work rate compared to control
groups (Frost et al 1995, Gundewall et al 1993, Kellett et al 1991,
Mitchell et al 1990, Moffett et al 1999).
are also pioneering investigations of the proposed mechanisms
contributing to chronic and recurrent low back pain by evaluating
the effects of specific exercise programs. Evidence to support their
efficacy is mounting (O'Sullivan et al 1997). There is strong
evidence that SMT is more effective in the management of chronic low
back pain than bed rest, analgesics, and massage, with six out of
eight trials supporting this evidence (van Tulder et al). More
importantly, the combination of SMT and exercise has increasing
support in the management of low back pain (Ottenbacher and Difabio
1994, Scheer et al 1995).
||Agency for Heath Care Policy and Research (ACHPR)
(1994): Acute low back problems in adults. Clinical Practice
Guideline no 14. US department of Health and Human Services,
Public Health Services. December, Rockville MD USA. |
||Avery (1997): The reliability of manual
physiotherapy palpation techniques in the diagnosis of
bilateral pars defects in subjects with chronic low back pin.
MPAA proceedings, 10th Biennial Conference Melbourne November.
||Donelson, Aprill, Medcalf and Grant (1997): A
prospective study of centralisation of lumbar and referred
pain: A predictor of symptomatic discs and annular competence.
Spine 22 (10) 115-122. |
||Frost, Moffett, Moser and Fairbank (1995):
Randomised controlled trial for evaluation of fitness program
for patients with chronic low back pain. British Medical
Journal 310 (21): 151-154. |
||Gundewall, Liljeqvist and Hansson (1993): Primary
prevention of back symptoms and absence from work.
Spine 18(5) 587-594. |
||Kellett, Kellett and Nordholm (1991): Effects of an
exercise program on sick leave due to back pain. Physical
Therapy 71 (4) 283-293. |
||Moffet, Torgerson, Bell-Syer, Jackson,
Llewlyn-Phillips, Farrin and Barber (1999): Randomised
controlled trial of exercise for low back pain: clinical
outcomes, costs and preferences. British Medical
Journal 319: 279-283. |
||Mitchell and Carmen (1990): Results of a
multicentre trial using an intensive active exercise program
for the treatment of acute soft tissue and back injuries.
Spine 15(6):514-521. |
||O'Sullivan, Twomey and Allison (1997): Evaluation
of specific stabilising exercise in the treatment of chronic
low back pain with radiologic diagnosis of spondylolysis or
spondylolisthesis. Spine 22: 2959-2967. |
||Ottenbacher and Difabio (1994): Efficacy of Spinal
Manipulation/Mobilisation Therapy. A meta-analysis.
Spine 10 (9) 833-837. |
||Scheer , Radack and O'Brien (1995): randomized
controlled trials in industrial low back pain relating to
return to work. Part 1. Acute Interventions. Arch Phys Med.
Rehab, Vol. 76, 966-973. |
||Phillips and Twomey (1996): A comparison of manual
diagnosis established by a uni-level lumbar spinal block
procedure. Manual Therapy 2, 82-87.
Tulder, Koes and Bouter (1997): Conservative treatment of
acute and chronic nonspecific low back pain. A systematic
review of randomised controlled trials of the most common
interventions. Spine 22 (18) 2128-2156. |
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|© By courtesy of the Australian Physiotherapy Association